Day: 09/30/2015

Comorbid diabetes and CVD increases mortality risk up to 7 times

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Patients with any combination of diabetes, stroke, or heart attack had a significantly increased risk of mortality than those who had only one of the three conditions, and each additional condition increased the risk exponentially, a large study from the UK has shown.

Compared to a reference group without any history of these cardiometabolic multimorbidities, the hazard ratio for all-cause mortality was 1.9, 2.1, and 2.0 for patients with diabetes, stroke, or heart attack, respectively, 3.7 for diabetes and heart attack, 3.8 for diabetes and stroke, 3.5 for stroke and heart attack, and 6.9 – about 7 times greater risk – for people with a history of all three. [JAMA. 2015;314:52-60]

“Our results emphasize the importance of measures to prevent cardiovascular disease in people who already have diabetes and, conversely, to avert diabetes in people who already have cardiovascular disease,” the researchers said.

The analysis included data from 689,300 participants from the Emerging Risk Factors Collaboration database at the University of Cambridge in the UK, which included 91 cohorts and baseline surveys collected since 1960. The death tally during the latest follow up in 2013 was 128,843. The comparator group included 499,808 patients since 2006 from the UK Biobank and at the latest follow up in 2013 there were 7,995 deaths.

All cause mortality rate also increased with each cardiometabolic multimorbidity patients had. Per 1,000 person-years adjusted to 60 years of age, the mortality rate was 15.6, 16.1, and 16.8 for patients with a history of diabetes, stroke or heart attack, 32.0 for patients with diabetes and heart attack, 32.5 for patients with diabetes and stroke, 32.8 for patients with stroke and heart attack, and 59.5 for patients with all three morbidities.

The researchers noted that a history of any two conditions was associated with 12 years reduced life expectancy while all three was associated with 15 years of reduced life expectancy, on par with the reduced life expectancy associated with lifelong smoking (10 years) or HIV infection (11 years) and the reduced life expectancy was most severe (23 years reduction) in younger patients who had all three conditions by the age of 40.

The researchers suggested shifting focus to preventive strategies to avoid multimorbidities, which occurred in about 1-3 percent of the cohorts they examined.

“An overemphasis on the substantial reductions in life expectancy estimated for the subpopulation with morbidity could divert attention and resources away from population-wide strategies that aim to improve health for the large majority of the population,” they said.

Etanercept reduces signs and symptoms of juvenile arthritis

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Treatment of juvenile idiopathic arthritis (JIA) with the tumour necrosis factor-alpha (TNF-α) inhibitor etanercept reduces the signs and symptoms of enthesitis-related arthritis (ERA), according to a two-phase study.

After 24 weeks of treatment, there was a marked improvement in disease activity measures that was sustained through to 48 weeks in patients receiving active therapy. [Arthritis Rheumatol 2015; 67:2240-2249]

At the end of the 24-week phase I open-label uncontrolled study, patients who received etanercept 0.8 mg/kg (maximum dose of 50 mg/week) had a 93 percent response rate on the ACR (American College of Rheumatology) Pedi 30 and Pedi 50 criteria, an 80 percent response rate based on Pedi 70 criteria, a 56 percent response rate based on Pedi 90 criteria, and a 54 percent response rate on Pedi 100 criteria. In addition, there was a reduction in all measures of disease activity and the mean number of tender and swollen joints by 91 and 97 percent, respectively. There was also a 94 percent reduction in the mean number of joints with active arthritis.

Physicians’ global assessment of disease activity improved by 91 percent whereas parents’ assessment of patients’ overall well-being and the Childhood Health Assessment Questionnaire disability index improved by 80 percent. The number of tender enthesis sites decreased by 75 percent. Similarly, there were improvements in back and nocturnal pain scores. The Bath Ankylosing Spondylitis Disease Activity Index  (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) decreased by 72 to 85 percent while the Juvenile Arthritis Disease Activity Score on 10-joint counts (JADAS 10)  decreased by 87 percent.

The phase II study included 38 patients – 20 were randomly assigned to continue treatment with etanercept up to 48 weeks and 18 to placebo. Disease flares, the primary endpoint of the study, occurred in 9 patients receiving placebo and in 3 patients receiving etanercept at week 48 (odds ratio, 6.0; p=0.02). No serious infections, malignancies or deaths were observed across the study period. The most frequently reported adverse events (AEs) were adverse drug reactions, gastrointestinal, and upper respiratory tract infections.

There is limited evidence for the efficacy of most treatments for JIA patients with ERA, said study author Dr. Gerd Horneff of the Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany. “However in this study, patients receiving etanercept responded rapidly to treatment… it was already evident at week 4 and increased in strength with continuous treatment.”

NASA CONFIRMS EVIDENCE THAT LIQUID WATER FLOWS ON TODAY’S MARS!

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New findings from NASA’s Mars Reconnaissance Orbiter (MRO) provide the strongest evidence yet that liquid water flows intermittently on present-day Mars.

Using an imaging spectrometer on MRO, researchers detected signatures of hydrated minerals on slopes where mysterious streaks are seen on the Red Planet. These darkish streaks appear to ebb and flow over time. They darken and appear to flow down steep slopes during warm seasons, and then fade in cooler seasons. They appear in several locations on Mars when temperatures are above minus 10 degrees Fahrenheit (minus 23 Celsius), and disappear at colder times.

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“Our quest on Mars has been to ‘follow the water,’ in our search for life in the universe, and now we have convincing science that validates what we’ve long suspected,” said John Grunsfeld, astronaut and associate administrator of NASA’s Science Mission Directorate in Washington. “This is a significant development, as it appears to confirm that water — albeit briny — is flowing today on the surface of Mars.”

These downhill flows, known as recurring slope lineae (RSL), often have been described as possibly related to liquid water. The new findings of hydrated salts on the slopes point to what that relationship may be to these dark features. The hydrated salts would lower the freezing point of a liquid brine, just as salt on roads here on Earth causes ice and snow to melt more rapidly. Scientists say it’s likely a shallow subsurface flow, with enough water wicking to the surface to explain the darkening.

“We found the hydrated salts only when the seasonal features were widest, which suggests that either the dark streaks themselves or a process that forms them is the source of the hydration. In either case, the detection of hydrated salts on these slopes means that water plays a vital role in the formation of these streaks,” said Lujendra Ojha of the Georgia Institute of Technology (Georgia Tech) in Atlanta, lead author of a report on these findings published Sept. 28 by Nature Geoscience.

Ojha first noticed these puzzling features as a University of Arizona undergraduate student in 2010, using images from the MRO’s High Resolution Imaging Science Experiment (HiRISE). HiRISE observations now have documented RSL at dozens of sites on Mars. The new study pairs HiRISE observations with mineral mapping by MRO’s Compact Reconnaissance Imaging Spectrometer for Mars (CRISM).

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The spectrometer observations show signatures of hydrated salts at multiple RSL locations, but only when the dark features were relatively wide. When the researchers looked at the same locations and RSL weren’t as extensive, they detected no hydrated salt.

Ojha and his co-authors interpret the spectral signatures as caused by hydrated minerals called perchlorates. The hydrated salts most consistent with the chemical signatures are likely a mixture of magnesium perchlorate, magnesium chlorate and sodium perchlorate. Some perchlorates have been shown to keep liquids from freezing even when conditions are as cold as minus 94 degrees Fahrenheit (minus 70 Celsius). On Earth, naturally produced perchlorates are concentrated in deserts, and some types of perchlorates can be used as rocket propellant.

Perchlorates have previously been seen on Mars. NASA’s Phoenix lander and Curiosity rover both found them in the planet’s soil, and some scientists believe that the Viking missions in the 1970s measured signatures of these salts. However, this study of RSL detected perchlorates, now in hydrated form, in different areas than those explored by the landers. This also is the first time perchlorates have been identified from orbit.

MRO has been examining Mars since 2006 with its six science instruments.

“The ability of MRO to observe for multiple Mars years with a payload able to see the fine detail of these features has enabled findings such as these: first identifying the puzzling seasonal streaks and now making a big step towards explaining what they are,” said Rich Zurek, MRO project scientist at NASA’s Jet Propulsion Laboratory (JPL) in Pasadena, California.

For Ojha, the new findings are more proof that the mysterious lines he first saw darkening Martian slopes five years ago are, indeed, present-day water.

“When most people talk about water on Mars, they’re usually talking about ancient water or frozen water,” he said. “Now we know there’s more to the story. This is the first spectral detection that unambiguously supports our liquid water-formation hypotheses for RSL.”

The discovery is the latest of many breakthroughs by NASA’s Mars missions.

“It took multiple spacecraft over several years to solve this mystery, and now we know there is liquid water on the surface of this cold, desert planet,” said Michael Meyer, lead scientist for NASA’s Mars Exploration Program at the agency’s headquarters in Washington. “It seems that the more we study Mars, the more we learn how life could be supported and where there are resources to support life in the future.”